The Effects of Coaching Pediatric Residents on Faculty Coaches' Relationships, Learning, and Professional Identity Formation

The Landscape of Pediatric Residency Coaching Programs in the United States

BACKGROUND

Coaching is a growing approach within graduate medical education for clinical and professional development. Little is known about the variation in the goals and implementation of residency coaching programs nationally.

OBJECTIVE

We describe the current national landscape of coaching programs across pediatric residencies, including program goals, barriers, and facilitators to coaching program implementation.

METHODS

In September-October 2022, we conducted a de-identified national cross-sectional, web-based survey of pediatric residency program directors. Data were analyzed using descriptive and inferential statistics and content analysis.

RESULTS

46% (84/183) pediatric residency program directors responded. 40% (34/84) reported currently having a coaching program, and 27% (23/84) were considering program development. Most programs coached residents at multiple training levels, with first-year residents most commonly coached. Attending physicians served as coaches in most programs (79%, 27/34), while 41% (14/34) utilize residents, fellows, or non-physicians as coaches. Top goals of coaching programs included skill development in professionalism (74%, 25/34), communication (68%, 23/34), clinical care (65%, 22/34), well-being (59%, 20/34) and remediation (50%, 17/34). Programs perceived multiple benefits of coaching including enhancement of resident performance, growth mindset promotion, support for struggling residents, community-building, and increased resident and faculty engagement. Barriers to coaching program implementation included time, funding, faculty buy-in, professional development needs, and burnout.

CONCLUSIONS

Coaching is an emerging approach to promoting trainee development, with at least 30% of pediatrics residency programs either currently employing or considering future coaching program development. Residency programs perceived benefits for both residents and faculty in skill development, sense of community, and engagement.

Creating a culture of coaching: examining clinical teachers' coaching behaviors through a behavior change lens

Despite the integral role that clinical teachers' coaching behaviors play in shaping residents' learning experiences, these behaviors are not always enacted. To better understand the behavioral determinants of coaching, the objectives of this study were to (a) identify barriers and facilitators of engaging in coaching behaviors using behavior change theories (Behavior Change Wheel, BCW; Theoretical Domains Framework, TDF), and (b) propose relevant interventions and policy changes to facilitate the engagement in coaching behaviors. Using a social constructionist approach, we interviewed 13 clinical teachers with relevant lived coaching experiences. We first used reflexive thematic analysis to analyze the data inductively. Second, we deductively mapped the themes onto the BCW and TDF to identify the behavioral determinants of coaching, relevant interventions, and applicable policy changes. Participants' perceptions of coaching behaviors were captured in six themes pertaining to clinical teachers' capability (a self-directed journey; a balancing act), opportunity (the show must go on; setting the stage), and motivation (call me coach; an audience for coaching). Although clinical teachers had the necessary coaching knowledge and skills, social and environmental constraints limited the practical implementation of these behaviors. This work supports applying behavior change theories in medical education research. Recommendations include shifting interventions beyond targeting individual-level knowledge to fostering coaching-supportive environments, including focusing on training, modelling, and enablement and developing policy-level supports such as guidelines, planning, services, and regulation.

Tips for developing a coaching program in medical education

This article provides structure to developing, implementing, and evaluating a successful coaching program that effectively meets the needs of learners. We highlight the benefits of coaching in medical education and recognize that many educators desiring to build coaching programs seek resources to guide this process. We align 12 tips with Kern's Six Steps for Curriculum Development and integrate theoretical frameworks from the literature to inform the process. Our tips include defining the reasons a coaching program is needed, learning from existing programs and prior literature, conducting a needs assessment of key stakeholders, identifying and obtaining resources, developing program goals, objectives, and approach, identifying coaching tools, recruiting and training coaches, orienting learners, and evaluating program outcomes for continuous program improvement. These tips can serve as a framework for initial program development as well as iterative program improvement.

Impact of a coaching program on resident perceptions of communication confidence and feedback quality

BACKGROUND

While communication is an essential skill for providing effective medical care, it is infrequently taught or directly assessed, limiting targeted feedback and behavior change. We sought to evaluate the impact of a multi-departmental longitudinal residency communication coaching program. We hypothesized that program implementation would result in improved confidence in residents' communication skills and higher-quality faculty feedback.

METHODS

The program was implemented over a 3-year period (2019-2022) for surgery and neurology residents at a single institution. Trained faculty coaches met with assigned residents for coaching sessions. Each session included an observed clinical encounter, self-reflection, feedback, and goal setting. Eligible residents completed baseline and follow-up surveys regarding their perceptions of feedback and communication. Quantitative responses were analyzed using paired t-tests; qualitative responses were analyzed using content analysis.

RESULTS

The baseline and follow-up survey response rates were 90.0% (126/140) and 50.5% (46/91), respectively. In a paired analysis of 40 respondents, residents reported greater confidence in their ability to communicate with patients (inpatient: 3.7 vs. 4.3, p < 0.001; outpatient: 3.5 vs. 4.2, p < 0.001), self-reflect (3.3 vs. 4.3, p < 0.001), and set goals (3.6 vs. 4.3, p < 0.001), as measured on a 5-point scale. Residents also reported greater usefulness of faculty feedback (3.3 vs. 4.2, p = 0.001). The content analysis revealed helpful elements of the program, challenges, and opportunities for improvement. Receiving mentorship, among others, was indicated as a core program strength, whereas solving session coordination and scheduling issues, as well as lowering the coach-resident ratio, were suggested as some of the improvement areas.

CONCLUSIONS

These findings suggest that direct observation of communication in clinical encounters by trained faculty coaches can facilitate long-term trainee growth across multiple core competencies. Future studies should evaluate the impact on patient outcomes and workplace-based assessments.